Senior Medical Billing Executives
Skills
About This Role
Overview
- A Sr. medical biller is responsible for submitting & resubmitting medical claims to insurance companies and payers on behalf of the hospital.
- The main purpose of the role is to adjudicate and process the account/claim with quality in a professional manner according to policy terms and conditions.
- The medical biller will hold responsibility for the account/claim until payment is done.
- He/ She needs to apply the clinical guideline and sound judgment of medical necessity when assessing the account.
- Additionally, the role will need to interpret and process claims with correct usage of standard codes (e.g.
- ICD, DRG, CPT, and HCPCS) applicable billing structure, policy terms, and benefits.
- Ensure that all medical information is kept confidential as per compliance.
- Roles and Responsibilities
- Reviewing patient bills for accuracy and completeness, and obtaining any missing information
- Evaluates and processes claims per insurance policy terms and conditions
- Work per company policies and procedures
- Identify and report back any type of claims observation or issues that may affect the process
- Evaluates and ensures that all claims denied or underpaid inappropriately by Payers are identified, appealed and reversed
- Reviewing claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries and makes recommendations for resolution
- Ensures that targets are met for department Turnaround time, Quality and Productivity
Education
- , Experience, and skills needed
- Expert knowledge of medical conditions, treatments, procedures and standard codes
- Willingness to work in different shifts
- Willingness to work from a different facility
- Analytical skills to review the account before submission to payer and ensure all required data elements are correct as per the insurance and medical code sets
- Basic understanding of the billing and payer adjudication guidelines related to DHA
- Basic knowledge of medical terminology
- Proficiency in the use of PCs and MS Office suite
- Excellent in communication skills
- Understanding of the various RCM departments
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